Physical Therapy: There Are No “Safe Spaces” on the Savanna

Modern Man is the direct descendant of animals that lived on the African savanna millions of years ago. Yes, animals, since they weren’t yet people, with cell phones and imaginations and heroes and appetites for expensive whiskey. Their concerns were much more basic, and almost entirely concerned with survival – waking up the next day, finding something to eat occasionally, and not being eaten yourself. Being hungry and injured was part of this pre-people existence, and you had to deal with it as best you could.

It’s critical to understand that our genetic and physical endowment is 99% the same as theirs. When you get to modern homo sapiens at about 200,000 years ago, we’re basically the same guys. Their physiology is our physiology, because physiology just doesn’t change that fast. Genetic change – the actual genes themselves which control the gross morphology of the organism – happens over very long time frames, while genetic expression – the way the genes make the proteins – is quite variable and subject to immediate changes in the environment, like the weather, and the food supply (and whether you’re a part of the food supply). Adaptations that an organism makes in response to environment are genetic expression problems, while changes in the number of bones in a species is a genetic change.

On
the savanna, if you tore a hamstring it was a more serious problem
than it is now. The Athletic Trainer, Certified, was not available.
There was no ice, no e-stim. There was no leg curl machine. In
contrast, there were predators with 2-inch fangs that served as the
therapists. So when you got hurt, you couldn’t stop moving, because
something would eat you. You hobbled along, moving as fast as
possible from hiding place to hiding place, the injury being moved
and worked the whole time. If you found something to eat, wonderful;
if not, you fasted. You were equipped for that too. And
you still are.

Guess
what happened? It healed, while being moved in a way that closely
resembled its normal function (limping is pretty close to walking).
And this healing environment restored normal function, because the
injury healed while immersed in its anatomically-determined
musculoskeletal role in the movement patterns it participates in. You
didn’t “let it heal,” because you didn’t have that luxury – you
made
it heal. It didn’t scar down, it returned to normal function, or at
least a high percentage thereof. And it may be that the fasting
contributed to the process by re-purposing tissues that were being
poorly or inappropriately utilized.

This
pattern existed as far back as predators and prey have existed –
for the entirety of vertebrate evolution. It is inherent in the
genetics of all vertebrates, and we’re merely the first ones to
discuss it amongst ourselves. Since we have to move – even if
injured – the genome has always
taken this into account and given all animals a way to survive a
non-fatal injury. The alternative was the loss of every injured
member of the species, so the trait persisted, because it had
to,
because everybody eventually gets hurt.

What
is a non-fatal injury? A muscle belly tear, a cut, a contusion, or a
broken minor bone. If you broke a femur on the savanna, you were
food, sorry. But an arm fracture can be dealt with if your actual ass
is on the line. A bad cut on a foot was a serious problem, as was
anything involving arterial bleeding. Anything that rendered you
unconscious for more than a minute or two also made you food. The
hyenas would happily eat you alive, starting at your crotch. It was a
tough world. But you were tough too, and if you could move, you got
the hell out of there. Because you had to. And
since you are genetically the same animal as the guys running across
the savanna, you can use the same approach to your injuries, if you
can gather up the balls.

When
you’re hurt, you have to learn to train through it. If you don’t,
you’re not going to be very good at this, because everybody
eventually gets hurt.
And the machinery is already in place to allow you to work through
the injury. We are fortunate in that a broken femur is not the death
sentence it used to be – we have surgeons and hardware now. But as
soon as the cast is off, you start loading the injury, very
carefully and
intelligently
because, after all, you broke one of the most important bones in your
body.

The
mechanism that repairs it involves loading it, so that the sides of
the fracture know that the fracture is there, and that the bone cells
must repair the damage. In this case, tiny movements along the
fracture plane is the signaling mechanism, and laying around on your
ass will not tell the fractured femur’s bone cells what you need them
to know. All the body’s tissues react the same way to a loss of
function through injury: if they are forced to gradually resume that
function, they will adapt
to the stress
and recover
the function. I hope this sounds familiar.

Gentle
Physical Therapy does not constitute a good use of time or money,
because therapy “modalities” that do not produce a stress on the
damaged tissue cannot produce an adaptation in the damaged tissue.
Anything that feels good in a Physical Therapy appointment is not a
contributor: “stress” that does not require recovery is not
actually stress,
and cannot produce an adaptation toward returning function.

The
mechanisms in place that heal an injury depend on the tissues being
subjected to enough stress that recovery is necessary, and this
process accumulates into a healed injury. And the best way to stress
the injury is to force it to perform some version of its normal
function. In the case of a broken femur, you trade a few weeks in a
cast for not being hyena food. In the case of a hamstring belly
injury, you wait 2 days for it to stop bleeding and then you get back
under the bar, carefully and appropriately. If you don’t know what
this means, ask.

So
when the doctor tells you to take it easy and let
it heal, he is 1.) telling you what he thinks you want to hear, or he
is 2.) covering his ass in case you push too hard and damage his
repair (I have been guilty of doing this myself, and I didn’t tell
him, but I learned a lot from the process), or 3.) the Doctor doesn’t
know what he’s doing. Number 3 is a distinct possibility, and the
therapist with the 2-inch fangs has a proven track record.

My
point here is that physical inactivity and productive human life are
incompatible, under all circumstances. Even when Doctors tell you
otherwise, “letting it heal” is a bad idea, and has been for a
very very
long time. You have to be smart about it, and that may involve asking
somebody else familiar with the process, but ask
them.
And start moving. 

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